Affordability of Treatment (can't keep increasing doses!)

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thursday

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So, I've been rather absent lately - Chester is doing ok, although his BGs are going up higher and higher everyday. I haven't updated his online chart in a while, though (I got a google redirect virus on my network in December which made accessing pages nearly impossible). Anyway - so his current BGs have been between 400 and 500. Rarely have I even seen Chester below 300 in the last 1 1/2 years. He's getting both methimazole (hyperthyroid) and levemir 2xs a day. The vet keeps having me back for "testing" so they'll give me another prescription. I had to take Chester in while I was 40 weeks pregnant to get another vial of the levemir! Which they only gave me 1 refill on. And he needs a new vial every two weeks with that high a dose! That stuff costs me $125 per vial, at every 2 weeks - that's $250 for LESS than a month. Plus $25 for methimazole. Plus I need 3-4x's the amount of litter per week because I can't get him regulated. That vet visit? Cost more than $700! In the past month, Chester has cost me more than 1/4 of our income. Currently he's costing me more than $6000 a year to keep at a BG of 350-450? Nowhere near regulation. An emergency out-of-town trip costs at least $80 per day to leave him. (Again, that's on top of regular costs of the three other cats). We couldn't afford it this summer, so he had to come with us. Chester was not at all amused.

Seriously, do you have any advice? We literally cannot afford this anymore. I'm going to have to start pulling money out of emergency funds if I can't find a solution. Obviously, I don't feel like I can just stop giving my cat insulin! :shock: That's just wrong. So... confused_cat
 
Re: Affordability of Treatment (can't keep increasing doses!

What dose are you at right now for Chester? I looked at your ss but it stopped last December.

If your vet is making you go for so many visits that are costing you, have you looked into a different vet?
Why are you buying only one bottle? Tell the vet that you want to get a 5pack of pens or the cartridges.

I can relate to the speed we go through insulin; one 3ml cartridge is lasting me about 5days for my two acros.

Did you want some info on SRT, the costs, etc?
 
Re: Affordability of Treatment (can't keep increasing doses!

Chester's mom-

No wonder you are stressed- that seems like very excessive requirements from the vet! I'd suggest you also look into getting a new vet as well. There's also a Feline Acromegaly Facebook group-joining the group has been a LIFE SAVER for me- the collective knowledge there of people who have successfully managed acro cats treatments is priceless. I actually got my cat SRT a few weeks ago, and the dr there even recommended the FB group esp when it comes to dosing requirements. Even she recognizes the value of that group. Anyways- I think you could get alot of help & input from alot of experienced people there & hopefully we can get your kitty on the right track & save your wallet & sanity!!
 
Re: Affordability of Treatment (can't keep increasing doses!

We're at 30 units, but clearly, that is too low given his recent numbers in the 460s. So I go through one 10 mL vial in about two weeks.

Obviously I need to find a vet who is willing to deal with him, since quite a few of the regular vets aren't interested in an acromegalic cat (have been seeing an internal medicine specialist). This time his white cell count was elevated and they gave me meds for that (which, incidentally, caused vomiting and loose stools all over the floor. sweet). Oh, and he didn't have a UTI like they thought, so no idea why the count was elevated.

As far as the SRT goes, I suppose it might be cost-effective, given how much I've already spent. But, I know there are no guarantees. He's never even been close to regulation either - never has he been consistently below BG 200 (except when he was in remission for 7 months). I am curious what the total cost might be.
 
Re: Affordability of Treatment (can't keep increasing doses!

I noticed you pay $125 for the levimir vial. I pay $95 at Costco. To get that price you have to join Costco and then sign up for the "uninsured medication plan" (or something like that). You dont have to belong to Costco to buy prescriptions there, but you do to get the special price. Another option is drugs from Canada, others may be able to guide you there, I've never done it, but I think its even less.

How old is Chester? I feel your pain- I've been doing it for 4 years and in retrospect, the SRT would have been far cheaper, even at $5000, (if it worked...) One year I added up all his other meds, the prozinc, the visits and it was around $4000/yr. Since then I have found cheaper ways to cope, I buy very little from the vet, I switched to the Relion meter, and I used FDMB to find where folks got their supplies cheapest. As for litter, I found a local pet store that sells it bulk- you just bring in your old litter buckets and scoop in what you need, and it is about 1/2 the cost of name brand, sold by weight. I assume he is on canned food (lower numbers and less pee). Hopefully you aren't buying RX food- you can save a ton by buying Friskies Special diet vs Rx.

I would definitely call around for a different vet, or at least speak up/complain about their Rx renewal policy. My vet will renew it with a phone call, and its good for like 6 months I think. At least you need to explain to your current vet that the gravy train is over, and your vet needs to work with you or lose you.

Another off the wall idea- if he has an enlarged heart, or proteinuria,(both common in acro) the drug benazapril which is a treatment for these, significantly increases sensitivity to insulin. One bean on FB went from like 96 units twice a day to like 50 units 2x/day after starting it. I believe it is an ACE inhibitor like enelapril.
 
Re: Affordability of Treatment (can't keep increasing doses!

There is also the option of figuring out what you *can* afford and treating to that level. I know that goes against the grain for a lot of people, but it makes sense to me in my situation. I can't afford high doses of insulin, and there's no way I could afford a treatment that costs thousands. So I have chosen to continue insulin for my cat at a level I can afford, on the theory that some insulin is probably better than none at all. His numbers range from 340 to the low 400s at all times, and his drinking and urine output are quite high. I expect that he will develop kidney failure sooner than he might otherwise have. Is this what I want for him? No. But we all have our limits. Think about what you would do, if you choose to dip into the emergency money and then you have an emergency of the type that you're saving it for--catastrophic illness that will mean a decrease in earnings, how this would affect mortgage payments, children's future education, etc. We love our cats, but would they want us to jeopardize our homes and health to keep them alive a little longer? Each of us has to answer these questions for ourselves, and my way might not work for you. But I wanted to put another voice out there, because all the ones I find here seem to be "treat at all costs," which I don't agree with. Different strokes for different folks, and those who are able and willing to treat at all costs, that's great for them. But it's not for everybody.

I agree about finding a vet who will work with you. That's key, no matter what choice you make about level of treatment.
 
Re: Affordability of Treatment (can't keep increasing doses!

McNally said:
There is also the option of figuring out what you *can* afford and treating to that level. I know that goes against the grain for a lot of people, but it makes sense to me in my situation. I can't afford high doses of insulin, and there's no way I could afford a treatment that costs thousands. So I have chosen to continue insulin for my cat at a level I can afford, on the theory that some insulin is probably better than none at all. His numbers range from 340 to the low 400s at all times, and his drinking and urine output are quite high. I expect that he will develop kidney failure sooner than he might otherwise have. Is this what I want for him? No. But we all have our limits. Think about what you would do, if you choose to dip into the emergency money and then you have an emergency of the type that you're saving it for--catastrophic illness that will mean a decrease in earnings, how this would affect mortgage payments, children's future education, etc. We love our cats, but would they want us to jeopardize our homes and health to keep them alive a little longer? Each of us has to answer these questions for ourselves, and my way might not work for you. But I wanted to put another voice out there, because all the ones I find here seem to be "treat at all costs," which I don't agree with. Different strokes for different folks, and those who are able and willing to treat at all costs, that's great for them. But it's not for everybody.

I agree about finding a vet who will work with you. That's key, no matter what choice you make about level of treatment.
Click to expand...
I am not clear on your stating that you are fine with treating your cat with less than what is needed. I would never consider a partial treatment. Please keep in mind that a cat with acromegaly has very little in common with a normal diabetic cat.
My answer is to do ALL that I can for my two acro cats; I would never ever consider allowing my cats to be in pain and suffering because I don't want to 'dip into savings'.
 
Re: Affordability of Treatment (can't keep increasing doses!

You could try using N insulin in conjunction with the Levemir. N is about $45 a vial and no script is required. My Tonis is on 7.5 units Levemir and between 1.5 and 2.5 units N.
 
Re: Affordability of Treatment (can't keep increasing doses!

Larry and Kitties said:
You could try using N insulin in conjunction with the Levemir. N is about $45 a vial and no script is required. My Tonis is on 7.5 units Levemir and between 1.5 and 2.5 units N.
Click to expand...

N insulin is not recommended for Acromegaly cats because of how N insulin works:

"The N insulin is a short acting insulin and probably does not have enough duration for most cats. It can have sharp steep drops (where the blood sugar drops too low) and then it can wear off quickly causing the blood sugar to increase quickly."
(http://sugarcats.blogspot.com/2006/03/types-of-insulin-used-to-treat-feline.html)

Please remember: http://felinediabetes.com/FDMB/viewtopic.php?f=14&t=973

Personally I wouldn't use N insulin in any cat but as we all know, ecid.
 
Re: Affordability of Treatment (can't keep increasing doses!

McNally said:
There is also the option of figuring out what you *can* afford and treating to that level. I know that goes against the grain for a lot of people, but it makes sense to me in my situation. I can't afford high doses of insulin, and there's no way I could afford a treatment that costs thousands. So I have chosen to continue insulin for my cat at a level I can afford, on the theory that some insulin is probably better than none at all. His numbers range from 340 to the low 400s at all times, and his drinking and urine output are quite high. I expect that he will develop kidney failure sooner than he might otherwise have. Is this what I want for him? No. But we all have our limits. Think about what you would do, if you choose to dip into the emergency money and then you have an emergency of the type that you're saving it for--catastrophic illness that will mean a decrease in earnings, how this would affect mortgage payments, children's future education, etc. We love our cats, but would they want us to jeopardize our homes and health to keep them alive a little longer? Each of us has to answer these questions for ourselves, and my way might not work for you. But I wanted to put another voice out there, because all the ones I find here seem to be "treat at all costs," which I don't agree with. Different strokes for different folks, and those who are able and willing to treat at all costs, that's great for them. But it's not for everybody.

I agree about finding a vet who will work with you. That's key, no matter what choice you make about level of treatment.
Click to expand...

This hurts my heart. I do not ever recommend that anyone deprive their cat of needed insulin. I was buying $100 vials of insulin every 9 days while on unemployment. It can be done. It should be done. Otherwise the cat's quality of life is in question. I am sorry you are having money troubles, but the truth is, we all believe in quality of life at all costs. If you need help with that, please check with the Lantus Emergency Fund or the Diabetic Cats in Need funds. Both are set up to help in cases like this.


Diabetic Cats In Need http://fdmb-cin.blogspot.com/
Lantus Land Emergency fund can be located on the Lantus board itself. Please just post and ask for help rather than letting the cat go without needed insulin.

Edited: Spelling
 
Re: Affordability of Treatment (can't keep increasing doses!

Larry - we appreciate your input to situations like people not being able to afford various treatments. However, in the case of an acrocat - one needs to understand the disease process we are dealing with here. Acro is not diabetes. Yes - acrocats have diabetes - but the whole process is different and one needs to understand how the insulin in working in these cats. Using a basal insulin like lantus or levemir in these kitties and then adding something like Nph into the picture is extremely dangerous as these cats have functioning pancreas'.

We are all into new ideas and input but sadly when the acromegaly is not fully understood by others some of these ideas can be deadly in an acrocat.
 
Re: Affordability of Treatment (can't keep increasing doses!

Thank you for the advice. Chester is somewhere between 12 and 14 years old. He was a stray house cat - already declawed & neutered, with an old worn collar but no tag.

What is the opinion on getting a teeth cleaning? Vet hasn't recommended it because he's never been well regulated.
 
Re: Affordability of Treatment (can't keep increasing doses!

if the teeth are a problem, fat chance regulating or bringing down dose and BG numbers.

I had Shadoe's dental done shortly after her acro dx and her dose was around 14u. After the dental, good cleaning and only 1 extraction, her dose dropped to 2.5u. Sure she's up to 19u now, but it made a big difference for her.

if there is no health reason, excluding the diabetes, then you should consider having the dental done as there may be some bad teeth or a cracked tooth that is interfering with regulation.

You may just find that his dose drops a fair amount and he is much happier after the dental
 
Re: Affordability of Treatment (can't keep increasing doses!

I agree with Gayle about getting the Dental done if teeth are not in good shape.

Combining Humulin N with a long lasting insulin is not good, however using R is a good approach. Start at a very low dose with the R (which lasts in the cat's body about 4 hours). R is cheaper than the long-lasting insulins and a vial lasts for a very long time. The R brings the blood sugar down quickly before the longer insulins kick in and helps bring the blood sugar down. (only use if your kitty is >400 or so)
 
Re: Affordability of Treatment (can't keep increasing doses!

I very much know how N works and that it is not really recommended for any cats. However, Chester was going from the 400s to only the 300s so I would not be concerned with dropping too low. I can give one 7.5 Levemir and 2 N at at BG of 136 and he only drops to 77. I also have very good experience with N for my Twigie. I could give her 0.8 unit of N with a BG of about 100 and she would only drop to the 70s.

Dragonnns said:
Larry and Kitties said:
You could try using N insulin in conjunction with the Levemir. N is about $45 a vial and no script is required. My Tonis is on 7.5 units Levemir and between 1.5 and 2.5 units N.
Click to expand...

N insulin is not recommended for Acromegaly cats because of how N insulin works:

"The N insulin is a short acting insulin and probably does not have enough duration for most cats. It can have sharp steep drops (where the blood sugar drops too low) and then it can wear off quickly causing the blood sugar to increase quickly."
(http://sugarcats.blogspot.com/2006/03/types-of-insulin-used-to-treat-feline.html)

Please remember: http://felinediabetes.com/FDMB/viewtopic.php?f=14&t=973

Personally I wouldn't use N insulin in any cat but as we all know, ecid.
Click to expand...
 
Re: Affordability of Treatment (can't keep increasing doses!

Comparing a diabetic cat to an acro cat is not logical.
Using R is preferred as your bolus if needed, not N.
 
Re: Affordability of Treatment (can't keep increasing doses!

Larry and Kitties said:
I very much know how N works and that it is not really recommended for any cats. However, Chester was going from the 400s to only the 300s so I would not be concerned with dropping too low. I can give one 7.5 Levemir and 2 N at at BG of 136 and he only drops to 77. I also have very good experience with N for my Twigie. I could give her 0.8 unit of N with a BG of about 100 and she would only drop to the 70s.
Click to expand...

I wouldn't give any cat insulin if their BG was 100 (that is high normal) and most definitely not a cat with acromegaly. Since their pancreas is working, if the tumor decides to stop working for a while you can suddenly find yourself with a cat in need of IV glucose, in a coma or worst case, dead.

Regardless, N insulin causes spikes due to the extreme drop and rebound so if you are working to get a flat curve in the right zone, N works counter to what the goal is.

If it works for you, great but I wouldn't recommend it, particularly as a way to cut costs as it can make things worse.
 
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